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Home My WebLink About7992-zNO. 4 TOWN OF SOUTHOLD BUH.I~ING DEPARTMENT Town Clerk's Office $ouihold, N. Y. Certificete Of Occupnncy No.. Z.~..1~.8 ..... Date ........... D.e.e... ? ......., 19.?~. THIS CERTIFIES that the building located at . ~..1~...o.f .S. ~.~n..d~...~... Street Map No.. ~X~ ........ Block No... X~l:... Lot No, .~X~ · · .]~a~;titUck.. I~,~ ,.. lq,Y,. conforms substantiaily to the Application %r Building Permit heretofore filed in this office dated ...... J. une.. 10, 19. ~.~ pursuant to which Building Permit No. dated .... J.u~..e....~ 1 .... , 19. ?.~, was issued, and conforms to ~ll of the require- ments of the applicable provisions of thE. law. The occupancy for which this certificate is issued is . .O.~.e, f..a~.i.ly dw..e.l.l.~z .Wi.th..ac.~e$~.o. ry. b.tllldi~g .&. ~dditlor~..t~. same The certificate is issued to I~. r.X'..i.e &..J.o. el~...V.~'~.ela~ ..... O~r~e.r.s ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Ap@royal N.,R; ............................. UNDERWRITERS CERTIFICATE No.. N.,R, ..................................... HOUSE NUMBER .... .1+35 .. Street . ~L~nda Jt~ ..... l~a~tituek ............... Building Inspector/ FOI?,~J[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'fOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7992 Z Permission is hereby granted to: · -B~.~ e-..¥-z~e e.]:a r ~-. &.. ~.~- £~ ..................... ...... ~'""/xayr~a~ze~,"~'¢ .................................. .................. · :~e'vi¢-~,c~r i"- ~' ~"~' ~- ..... t"1'~ ~6 ........ w Lu:L~`~...~....a~.~.~.:g.~n...~`~..e.~`.~.~.~.ng...a¢~e$~c~y...btti:.1~.~g ....................................... at premises located at ....~¢.,~ .~.+~..~..i~...]~.'.~L~c]:&.. '~o~¢1'"('"~9/~'";~:~t~,~-'['~:') .................................. ........................................................ ~ %'t ~t't;u'c'k" "I? ;' it%' .................................................................... pursuont to opplication doted .......................... ~l.~j.~ .....~0' ........... 19~...., and opproved by the Building Inspector. Fee SJ.-t~,.OC- ............ I~)RM NO. $ TOWN OF SOUTHOLD , Buildi~tg Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY hlstructions A. This applicahon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use' 1. Final survey of property with accurate location of all buddings, property lines, streets, aha unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), l',lon-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey~of property showing all property lines, streets, buildings and unusual natural ar topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3 Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 Date ~,~overabe r New Building ................ Addition ...... ~ ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~z':[valse P,c~. ext,, off T,~ncla ..................... Eft] ................................................. Owner Or Owners Of Property ....................................................................................................................... I~ap ~ 5448 Subdivision ................................................................ Lot No ............. Block No ............. House No.~.0..~.0.. Ruth /? Permit No...?..~.~;~..4 ..... Date Of Permit ...6/..~,~, ..... ~.Applicant ..... ~.a~'.lq..~.e....~.~.~.~.~F], ........................ Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... 5. O0 Fee Submitted $ .................................... Construction on above described building and permit.,~eets all applicable 9od~s and regulations. ~ ............. ..... Sworn to before me this .... ...... day ...... Notary Public ..~~ ...... County WAITER F. tOC~~°r seal) Res(drag in Suffolk k COun~ Clerk's No Approved ..................................... i IrO]a~ NO, I TOWN C~F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTfiOLD, N. Y. 19...../.~ Permit No .................................... Disapproved a/~- ~ ........................................................................ ............................................. ................................ .................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s application must be completely fdled m by typewriter or ~n ink and submitted in triplicate to the Building Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed descnption of layout ofpropert¥ must be drawn on the diagram which is part of th~s application. c. The work covered by th~s application may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Budding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e NJ) building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, crdinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ............. ................... (Signature of applicant, or nome, if a corporation) , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder .... .0..~..:.'1.,~ .................................. ~ .................. ~; ............... : ........... ;. .......... :.:. ............ ~. ............... i ........... ~' .................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Budder's License No .................................................... Plumber's License No ................................................. Electrician's L~cense No ............................................ Other Trade's License No ............................................... 1 Location of land on wh,ch propo?ed work w~dl be done Map No .... ,~.-'.t-7~...~' ..5'. .......... x.... Lot No umber .~..~'~, k)~ xk).~ ,t....~...~ '~' ..... L-''C')''''~' ~.'''~'' ..... '~'.~..Y~-.-q~.~.b ... '~",~" '~ ~'i'~'~'i~'' Street and N .......... .°k...,..~.....~...,~, ........................ Municipality 2 State exishng use and occupancy of premises and intended use and occupancy of proposed construction: ..~..h~..~.~ ~ ~?,.'~ ~ .~....~....~..," ~ ~ a Exisiting use and occupancy ....... ~...Lr:..~ ........ ........ .~..)q ..C....~ .................................. b Intended use and occupancy .:..~...OL.....~.~...~......-:...Lff~.....~.'.......~..~ ...... .\...?.. ......... .C.k....C...f'..~..~....~.~..h. ............... .. "Nature of work (check which applicable) New Building .................Addition ................ Alteration ......... Repair .................. Removal ................ Demoht:or. ........... .~ ...... Other Work ~...X,.'-J~.f~.g.:l..p...~...~.L.~..q.q.~.~.~. _ ~)/ ~ ~/. ,, (Description) / 4 bstimated Cost .... .~....~..'~)... ........................................ Fee ...... ./...M.... :.,~:: .......................................................... (to be pa~d on filing this application) 5 If dwelling, number of dwelling umts ........................ Number of dwelling units on each floor ....................... If garage, number of cars ................................................................................................................................ 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........... ~ ......... 7 Dimens,ons of existing structures, if any' Front...~.: ~/' ................ Rear ...... .~...~.. ................. Depth/..~.. ..... ..~....~. Height ..J'..~..~ ............ Number of Stones ...~. ~ ..~. ......................................................................................... Dimensions of same structure with alterat,ons or addmons Front ......... .~.~....~....~ ............... Rear ...~..~...]. .......... / / Depth .~; ......................... He,ght ..... .:..-...." ....... Number of Stones .... ..~...../2....~.. .............. /'~./ · /? ¢¢ / 8 D~mensJons o,f~ent~re new construction' Front ................................ Rear ....... /. ................. Depth .....,~.. ......... Height ...... J.~... ........ Number of. Stories ...... 6:..~.....(~.. ............................... ? ................................ ! ~ , ~/ ....... 9. S,ze of lot: Front ...... ~ _ - ~ , ~_~.~'"'"~""~'": .................................. ,~ Rear .../....~..~...~...~...~. ................. _/_;' Depth.b ,,"("~?"'~'r' .............. 10 Date of Purchase .... /.d.~(~......(.~....M.. '.~ .........Name of Former Owner ..Z~.J:T~..~ ........ .'C.J...(.~..~ ................. I 1 Zone or use distr,ct in wh,ch prem,ses are s,tuated ... fz~..~.f..~.*'/~...~...l ................................................ 12 Does proposed construction violate any zomng law, ordinance or regulation .... ~..~ ........................................... 13 W~II lot be regraded ............/~...,.~ ......... Will excess.,fill be removed from pre.m~ses' ( ) Yes ()k) No 14 Name of Owner of prem,ses-~-..C..~.}:'..k..R.......,..~...~..~.....£L.~.~..=... Address ..L..¢~:,.Z.,..~....~2...~b.~... Phone Name of Architect ........................ Address ................................ Phone No ...................... Name of Contractor .......................................... Address ................................ Phon~' No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions fron property hnes Gwe street and block number or descr~phon according to deed, and show street names and ind~cat.- whether interior or corner lot ~TATE OF NEW YORK, ~ ¢ c COUNTY OF ........................... ............................................................................................... being duly sworn, deposes and says that he ~s the apphcon (Name of mdiwdual s~gn~ng contraclO above named He ~s the ............................................................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s~ duly authorized to perform or have per~ormed the smd work and to make and f~l this apphcation, that all ~t. atgfr~ents contmned in th~s apphcation are true to the best of h~s knowledge and behef; on, tha~ the work w~ll be perf'orr)n~d/Jn the manner set forth ,~ the opphcahon filed therewith. Sworn to before me this / / / ......... ~ ......day of/./.-..,~4..'~-/.....~¢~....../,~. ......... , 19.. ~. Notary Publ(c, ....~..,.....,~ ....... County .......................................................................................... "~ / ~gll~l~A I~IAZ // (Signature of applicant) Nolary Pubhc, Slate ol,~ew )~6rk Iqo. 41-0946~/~ 8 Quahfmd in Que~s C?'unly Certificate f~ied in Ne~ Y'6rk Count~; Commission Expires March 30, 1977